Examining Smoking Trends In The Upper Midwest And Northern Plains

Smoking rates may be falling across the United States, but new state-by-state data shows the habit still has a strong foothold in parts of the Upper Midwest and Northern Plains — including North Dakota.

A new map from Visual Capitalist highlights adult smoking rates across the country, and while the national trend has moved downward over the years, the numbers are still eye-opening. In North Dakota, about 13% of adults smoke, putting the state above some of its regional neighbors and well above the lowest-smoking states in the nation.

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Regional Smoking

Regional Rates Remain Elevated as Smoking Varies Widely Across the U.S.

South Dakota posted one of the higher smoking rates in the region at around 15% of adults, while Minnesota and Montana each came in at roughly 12%. Those numbers show that while smoking is no longer as common as it once was, it remains a significant public health issue across the Dakotas and surrounding states.

At the top of the list nationally is West Virginia, where about 20% of adults still smoke — the highest rate in the country. On the other end of the spectrum is Utah, where just 6% of adults smoke, making it the lowest-smoking state in the nation.

Where You Live Still Plays a Major Role in Smoking Rates and Health Risks

The map underscores how smoking habits can vary widely depending on where you live. Factors such as culture, income, access to healthcare, education, and public health efforts often play a role in those differences. States with strong anti-smoking campaigns and lower tobacco use tend to see better long-term health outcomes, while states with higher smoking rates continue to face increased risks tied to heart disease, cancer, and other chronic illnesses.

Even with decades of awareness campaigns and restrictions on tobacco advertising and indoor smoking, millions of Americans still light up. For North Dakota, the latest numbers suggest progress has been made, but there is still room to improve. While 13% may not sound overwhelming at first glance, it still means more than one in every 10 adults in the state is smoking.

The good news is the long-term trend is moving in the right direction. But for many states — especially across the Plains and Appalachia — smoking remains a stubborn health challenge that hasn’t gone away just yet.